Presentation
Acute right lower abdominal pain - appendicitis?
Patient Data
Appendix appears normal and is compressible.
Large mass adjacent to left kidney, appears to originate from pancreatic tail. Possible intralesional flow on color Doppler.
The patient was admitted to a surgical department for further investigation of the abdominal mass.
Abdominal CT was performed.
Large, solid, heterogeneous, well-circumscribed mass originating from pancreatic tail. No perilesional fat stranding.
Case Discussion
Presented to the emergency department with constant abdominal pain that began abruptly the previous night and wandered from the central abdomen to the right lower quadrant.
In the emergency department:
Subfebrile fever; diffuse abdominal tenderness, more pronounced in the right upper and lower quadrants; slight leukocytosis with neutrophilia; CRP within normal limits.
Abdominal ultrasound was performed, which ruled out acute appendicitis. Large incidental mass probably emanating from the pancreatic tail. CT confirmed this. Given that the patient was a young woman and that the mass was asymptomatic, the putative diagnosis was of a solid pseudopapillary tumor.
The patient underwent distal pancreatectomy (a misnomer) 2 and splenectomy. The pathology report confirmed solid pseudopapillary tumor with reactive changes in several regional lymph nodes.
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